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41. Candidate Measure Submission Form (CPCF) | Agency for Healthcare Research and Quality
    www.ahrq.gov/policymakers/chipra/cpcf-form3.html
    December 01, 2013 - Candidate Measure Submission Form (CPCF) CHIPRA Pediatric Quality Measures Program (PQMP) The … CHIPRA Pediatric Quality Measures Program (PQMP) Candidate Measure Submission Form (CPCF) was approved … Include references related to specific points made in your narrative (not a free-form listing of citations

42. SOPS® Database De-Identified Data Research Abstract Form (doc file)
    www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2024-sops-deidentified-data-research-abstract-form.docx
    January 01, 2024 - SOPS® Database De-Identified Data Research Abstract Form Agency for Healthcare Research and Quality … (AHRQ) SOPS® Database De-Identified Data Research Abstract Form Instructions Please use this form … Save this completed form with your last name in the file name (e.g., “Smith SOPS De-identified Research … Date Completing Research Abstract Form       Project Title       Purpose       Hypotheses       Methodology … SOPS De-identified Research Abstract Form Last Updated: April 2024 2 Primary Contact Information Name

43. SOPS® Database De-Identified Data Research Abstract Form (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2024-sops-deidentified-data-research-abstract-example.pdf
    January 01, 2024 - SOPS® Database De-Identified Data Research Abstract Form Example SOPS De-identified Research Abstract … Form Last Updated: April 2024 1 Agency for Healthcare Research and Quality (AHRQ) SOPS® Database … De-Identified Data Research Abstract Form EXAMPLE OF A COMPLETED FORM This completed abstract … presents an example of how to complete this form. … Example SOPS De-identified Research Abstract Form Last Updated: April 2024 4

44. ADE and Near Miss Incident Classification Form | Digital Healthcare Research
    digital.ahrq.gov/health-it-tools-and-resources/ahrq-funded-project-resources-archives/ade-and-near-miss-incident
    January 01, 2023 - ADE and Near Miss Incident Classification Form Description This form is used … Document Type Data Collection Form Document Source Statewide Implementation of Electronic … Health Records PDF ADE and Near Miss Incident Classification Form

45. Labor and Delivery Unit Staff Safety Assessment | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/assessment.html
    July 01, 2023 - Who should complete this form: All L&D staff (clinical and nonclinical) How to complete this form: … Submit your completed safety assessment form in the location designated by the unit safety coordinator … When to complete this form: All L&D staff should complete this form at least semiannually.

46. Medication Error and Near Miss Classification Form | Digital Healthcare Research
    digital.ahrq.gov/health-it-tools-and-resources/ahrq-funded-project-resources-archives/medication-error-and-near-miss
    January 01, 2023 - Medication Error and Near Miss Classification Form Description This is a near … miss classification form for an adverse drug event study. … Document Type Data Collection Form Document Source Statewide Implementation of Electronic … Health Records PDF Medication Error and Near Miss Classification Form

47. Appendix K. CAUTI Case Review Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/tools/cauti-surveillance/review-form.html
    March 01, 2017 - CAUTI Case Review Form AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Purpose … The CAUTI Case Review Form is a performance improvement look-back tool that assists long-term care … This form is designed to identify contributing factors to and the root cause of a CAUTI that meets the … Complete this form in its entirety.

48. Staff Safety Assessment | Agency for Healthcare Research and Quality
    www.ahrq.gov/hai/cusp/toolkit/staff-safety-assessment.html
    December 01, 2012 - Safety Assessment CUSP Toolkit Determine what risks are present in your unit Purpose of this form … : This form is designed to tap into your experience at the front line of patient care to determine what … How to complete this form: Provide as much detail as possible when answering the two questions below … When to complete this form: This form can be filled out by any health care provider at any time. … At a minimum, health care providers should complete this form semiannually.

49. Team Antibiotic Review Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/antibiotic-use/acute-care/improve/team-review.html
    November 01, 2019 - Team Antibiotic Review Form Team Antibiotic Review Form  (DOCX) Completion Guide for Team … Antibiotic Review Form  (PDF)

50. U.S. Preventive Services Task Force - Contact Form | United States Preventive Services Taskforce
    www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/contact-us-form
    April 06, 2025 - Preventive Services Task Force - Contact Form Share to Facebook Share to X … WhatsApp Share to Email Print Indicates required field Form-wrapper … You can use this form to contact the U.S.

51. Appendix 1-A. Release Forms | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/publications/pubcomguide/pcguide1apa.html
    July 01, 2024 - Release Forms Appendix 1-B. Trademarks Appendix 1-C. … in Microsoft Word: Release Form for AHRQ To Use Copyrighted Material (Word, 42 KB). … Release Form for Use of Previously Recorded Audiovisual Materials, Including Photographs (Word, 46 KB … Meeting Participant Release Form (Word, 42 KB). Meeting Participant Sign-In Sheet (Word, 47 KB). … *Note: Grantees may use these forms if they do not have forms of their own; however, grantees are not

52. Hospital Survey on Patient Safety Culture Database: Hospital-Identifiable Research Abstract Form (doc file)
    www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2024-HSOPS-Identifiable-Research-Abstract.docx
    January 01, 2024 - Hospital Survey on Patient Safety Culture Database: Hospital-Identifiable Research Abstract Form Agency … (AHRQ) Hospital Survey on Patient Safety Culture Database: Hospital-Identifiable Research Abstract Form … Instructions Please use this form to describe the research for which you require hospital-identifiable … Save this completed form with your last name in the file name (e.g., “Smith Hospital-Identifiable Research … SOPS Hospital-Identifiable Research Abstract Form 1 Last Updated: April 2024 Primary Contact Information

53. Get Involved | CDSiC
    cdsic.ahrq.gov/cdsic/contact-form
    : Skip to main content HHS.gov Menu Main navigation CDS Home CDS Innovation Collaborative An official website of the Department of Health & Human Services …

54. The Four Moments of Antibiotic Decision Making Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/antibiotic-use/long-term-care/four-moments/review-form.html
    June 01, 2021 - The Four Moments of Antibiotic Decision Making Form A facility's antibiotic stewardship team … is encouraged to use Four Moments of Antibiotic Decision Making Form to review 5–10 residents each month … The Four Moments of Antibiotic Decision Making Form  (PDF, 319 KB) Completion Guide for the Four Moments … of Antibiotic Decision Making Form  (PDF, 265.3 KB)

55. DATAFORM 5 ADE and Near Miss Incident Classification Form (pdf file)
    digital.ahrq.gov/sites/default/files/docs/resource/Dataform_5_ADE_and_Near_Miss_Incident_Classification_Form.pdf
    June 16, 2021 - DATAFORM 5 ADE and Near Miss Incident Classification Form DATAFORM 5 ADE and Near Miss Incident … Classification Form 1. … printed template Page 2 of 3 6/6/05 Dataform 5: ADE and Near Miss Incident Classification Form … No Page 3 of 3 6/6/05 Dataform 5: ADE and Near Miss Incident Classification Form Version 5.0 … DATAFORM 5 ADE and Near Miss Incident Classification Form

56. DATAFORM 3 Medication Error and Near Miss Classification Form (pdf file)
    digital.ahrq.gov/sites/default/files/docs/resource/Dataform_3_Medication_Error_and_Near_Miss_Classification_Form.pdf
    June 16, 2021 - DATAFORM 3 Medication Error and Near Miss Classification Form WBD DATAFORM 3 Medication Error … and Near Miss Classification Form 1. … Research and Practice 5/27/05 Dataform 3: Medication Error and Near Miss Classification Form … 2.02 Underdose 2.03 Dose omitted (from order/when dispensed) 2.04 Dose units omitted 2.05 Dose form … Research and Practice 5/27/05 Dataform 3: Medication Error and Near Miss Classification Form

57. Achieving Individualized Precision Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form - Final Report | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/achieving-individualized-precision-prevention-ipp-through-scalable/final-report
    January 01, 2023 - Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form … Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form … Prevention (IPP) through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form

58. User interface accelerators for clinical documentation in Smart Form. | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/evaluating-smart-forms-and-quality-dashboards-electronic-health-record-ehr-6
    January 01, 2023 - User interface accelerators for clinical documentation in Smart Form. … User interface accelerators for clinical documentation in Smart Form. … for… Principal Investigator Middleton, Blackford Project Name Evaluating Smart Forms

59. Suggested Timeline for Implementation (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/timeline-tasks.pdf
    June 01, 2021 - Monthly Data Collection Form Learning From Antibiotic Adverse Events Form Hold 6th Antibiotic … Stewardship Team meeting • Use the Staff Safety Assessment and Learning From Antibiotic Adverse Events forms … • Use the Staff Safety Assessments and Learning From Adverse Antibiotic Events Forms to identify … Complete 5–10 per month • Monthly Data Collection Form. … Monthly • Learning From Antibiotic Adverse Events Form. Discuss quarterly.

60. Labor and Delivery Unit Safety Issues Worksheet for Senior Executive Partnership | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/worksheet.html
    July 01, 2023 - Health care providers and senior leader(s) How to complete this form: Provide as much detail as possible … When to complete this form: It should be completed at least semiannually.